Opinion Review
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jul 21, 2019; 25(27): 3468-3483
Published online Jul 21, 2019. doi: 10.3748/wjg.v25.i27.3468
Stricter national standards are required for credentialing of endoscopic-retrograde-cholangiopancreatography in the United States
Mitchell S Cappell, David M Friedel
Mitchell S Cappell, Division of Gastroenterology and Hepatology, William Beaumont Hospital, Royal Oak, MI 48073, United States
Mitchell S Cappell, Oakland University William Beaumont School of Medicine, William Beaumont Hospital, MI 48073, United States
David M Friedel, Division of Gastroenterology, New York University Winthrop Medical Center, Mineola, NY 11501, United States
Author contributions: Cappell MS initiated this opinion piece; Cappell MS and Friedel DM wrote the manuscript.
Conflict-of-interest statement: None for either Dr. Cappell or Dr. Friedel. In particular, Dr. Cappell, as a consultant for the United States Food and Drug Administration (FDA) Advisory Committee for Gastroenterology Drugs, affirms that this paper does not discuss any proprietary confidential pharmaceutical data submitted to the FDA and reviewed by Dr. Cappell. Dr. Cappell was until 1 year ago a member of the speaker’s bureau for AstraZeneca and Daiichi Sankyo, co-marketers of Movantik. Dr. Cappell has had one-time consultancies for Mallinckrodt and Shire. This work does not discuss any drug manufactured or marketed by AstraZeneca, Daiichi Sankyo, Shire, or Mallinckrodt.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Mitchell S Cappell, MD, PhD, Chief Doctor, Professor, Division of Gastroenterology and Hepatology, William Beaumont Hospital, MOB #602, 3535 West Thirteen Mile Rd, Royal Oak, MI 48073, United States. mitchell.cappell@beaumont.edu
Telephone: +1-732-991-1227 Fax: +1-248-551-7581
Received: February 27, 2019
Peer-review started: February 27, 2019
First decision: May 9, 2019
Revised: May 16, 2019
Accepted: June 23, 2019
Article in press: June 23, 2019
Published online: July 21, 2019
Core Tip

Core tip: An additional, optional year of endoscopic-retrograde-cholangiopancreatography (ERCP) training was added because of limited ERCP exposure during standard-three-year-gastrointestinal-fellowships and its greater endoscopic technical difficulty. Yet, many graduates from standard-three-year-fellowships intensely pursue ERCP privileges despite inadequate numbers of ERCPs, or low successful duct cannulation rates. Hospital credentialing committees have sometimes disregarded recommended ERCP credentialing guidelines. Consequently, some gastroenterologists learn ERCP “on the job”, after completing standard GI fellowships, during unsupervised practice. National, mandatory, standards for ERCP are advocated, including number (≥ 200-250) of performed ERCPs, and ≥ 85%-90% successful cannulation rate. An independent entity should oversee ERCP credentialing to prevent politicking within hospital committees.